Religious Freedom in an Emergency Department

I worked as a staff nurse in a pediatric emergency department from the time I graduated nursing school through when I received my master’s degree in nursing, in total between 6-7 years. I started at age twenty-two.

I enjoyed being twenty-two. I lived in a left wing land with Obama soon to be entering office and even though I attended school in very conservative upstate New York I never really internalized the level of conservatism that abounds in most of the country. I was working in an inner city hospital in the Northeast happily back in my liberal bubble.

The Emergency department was a hodgepodge of characters. Attendings, residents, nurses, techs, EMTs, police, security, administration, social workers, psychiatrists, surgeons, pharmacists…you name it and we had them at some point working in the emergency department. At that age and in that geographical area I basically assumed every one was pro-choice, pro-LGBT rights, and pro-healthcare for all.

I was wrong.

One day I was taking care of a patient who was raped. She was young (children’s hospital being under 18), and scared, and traumatized. The physician spoke to her mom and her about all the options available to her. Rape kit, medications, etc. One of the options was the morning after pill which prevents pregnancy from occurring. The mom and the patient wanted to discuss it and they agreed to certain things but initially did not want the morning after pill. No one pushed it, as that’s not our role.

Later, after all the tests and interviews and near time for discharge the mom approached me and said they decided she would take the morning after pill. I said sure, and went to the desk where the physicians were sitting. The Attending and the resident were sitting next to each other making my life easier. I told them the patient changed her mind and wanted the morning after pill.

The Attending looked awkward and said, “Okay, but I can’t order it,” and he looked at the resident, and she looked awkward and said, “Yeah I can’t order it either,” I stared at both of them like they had two heads and genuinely asked, “Is there something wrong with your computers?” They both shook their heads and avoided eye contact with me. I stood there staring at both of them and said, “Well some one has to order it because this kid was raped and she doesn’t want to get pregnant. So what’s the freaking problem?”

It still had not penetrated my head that they couldn’t order it because their religious beliefs prevented them from ordering it. I literally was still thinking there was a technical issue and for some reason the system was not allowing them to order it. I know it sounds so stupid, but I was young and naive and hopelessly liberal.

Another Attending overheard our exchange and likely heard my statement, and saw me standing there with my hands on my hips glaring at the computers and the doctors, and quietly said, “I’ll do it.”

That’s when I got it.

I remember walking away silently to the medication room. Later I was with the Attending who ordered it and I asked what would have happened if it was night shift and they were the only two doctors in the ED? He told me they would have ordered it. But I wasn’t so sure. I’m still not. I’m thinking if it was night shift and they were the only ones in the ED I’d be trekking up to the ICU and finding one of their Attendings to place the freaking order.

This happened eleven years ago. I still remember it vividly. For many reasons.

For starters I never envisioned patient care being affected by some one’s religious beliefs. I remember we had a travel nurse from North Carolina. She told me they don’t even offer it to rape victims where she worked down south. I thought that was shitty. Still do.

If birth control is against your religious belief I would hope that murder, rape, pedophilia, burglary, tax evasion, etc. are also against your religious beliefs. Do physicians regularly screen their patients for committing tax fraud? Because let’s be real, everyone in America who owns a business probably has kept cash for themselves and not reported it as income. Do you not treat them because they are stealing and committing tax evasion? Do you not treat men who’ve committed rape when they arrive in the ED for a heart attack? Do you not treat the man who arrives in the ED after having a heart attack while he is screwing a prostitute who also arrives with him, but quickly exits when she hears the wife is on the way (Yes that’s happened)? Why is it that you can pick and choose what religious beliefs you follow at work and which you don’t?

You shouldn’t, hence why religious beliefs should not affect the delivery of healthcare.

Here’s one that will totally trip you up- would you refuse to treat a pregnant transgender man who wants to have the baby? What about all that pro-life chatter? Or does pro-life mean you’re only going to treat the lives that matter to you? 

The Health and Human Services Department recently formed a committee to explore religious freedom within healthcare. Per LamdaLegal article the aim of the committee is to protect from consequences health care providers who refuse services to patients due to religious beliefs. It makes me sick that in the United States we have one of the highest Maternal mortality rates in the Western world, but no we aren’t going to form a committee to save women’s lives during childbirth.

In 2009 a study out of Harvard wrote that about 45,000 deaths in one year were attributed to people not having health insurance. But we are focused on decreasing access to care instead of increasing it. Psychiatric hospitals are losing funding, states are shutting down facilities, families with severely autistic individuals have no long term plans for placement. The United States has one of the highest infant mortality rates in the Western world. But we can’t focus on that. Our current administration is instead focusing on restricting care.

But I digress. My patient got her medication preventing pregnancy. Thanks to an Attending who was not conflicted about ordering it.

My heart aches for the number of people within the LGBT community, who if this committee actually makes progress, will hesitate to receive healthcare services because they are fearful of being refused services.

Religious freedom is a beautiful component to American society and the foundation on which our country was built. But religious beliefs do not belong in healthcare delivery. Science, education, and clinical experience should be the basis of medical decision making.

 

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